About Surgical Oncology

Why select a Surgical Oncologist?

Surgical oncologists are general surgeons who have completed an additional three years of fellowship training in all cancers in order to diagnose, biopsy and surgically treat cancers of all types. Choosing to use a surgical oncologist can significantly improve your procedure outcome and chances of survival(see abstract of article from the US Department of Health and Human Services - National Institutes of Health website Mechanisms of Improved Outcomes for Breast Cancer between Surgical Oncologists and General Surgeons).

During Identification and Diagnoses the Surgical Oncologist's familiarity with cancers and their progressions allows them to better recognize malignancies and manage care for their patients.

During Surgery the Surgical Oncologist has extensive experience with cancer procedures because it is their career focus. The Surgical Oncologist statistically has a lower rate of positive margins (cancerous cells in the edge of the tissue removed), less need for second operations, and a higher long term survival rate in cancer surgeries than those same surgeries performed by a general surgeon.

After Surgery the Surgical Oncologist uses their specialized training and expertise to better manage and coordinate cancer care for their patients to minimize recurrences and improve the overall outcome for their patients.

Using a Surgical Oncology Cancer Specialists will improve your outcome and chances of survival.Some cancer surgeries are more technically challenging operations than others. Examples of these procedures include colon resections, liver resections, removal of the pancreas, lung, or esophagus. It has been repeatedly demonstrated that there is an improved outcome for patients who receive care for their malignancies by a Surgical Oncologist rather than a general surgeon. Hospital stay and complications as well as risk of recurrence and survival are well documented to be improved when surgery and care is delivered by someone whose entire practice and career focus is the care of people with cancer. General surgeons spend most of their time removing gallbladders, fixing hernias and obstructed blood vessels and doing emergency surgeries,not cancer care. Frequently, patients with “common variety” cancers are cared for by general surgeons in most communities because it’s simple, routine, and just needs to be “cut out”. Right? Wrong! What difference does it make? An enormous difference! These cancers are often felt to be “common variety” or “routine” by everyone but the patient and Surgical Oncologists. Consider a study reported in the Annals of Surgical Oncology in 2005 examining the outcome of 29,666 women with breast cancer cared for in Los Angeles County (Annals of Surgical Oncology 10:606-615). This study examined the difference in long term outcome depending only on whether a patient was cared for by a general surgeon or had their entire cancer care coordinated by a Surgical Oncologist. Treatment by a Surgical Oncologist resulted in an astounding 33% reduction in the risk of death at five years compared to when care was delivered by a general surgeon. In another study at the University of Massachusetts (Annals of Surgical Oncology 5:28-32) the impact of Surgical Oncology was examined by determining the quality of breast cancer surgery at the university in women with cancers that could not be detected by physical exam. Surgical Oncologists achieved a much lower rate of positive margins (cancer cells extending to the edge of the tissue removed) at the time of cancer removal (25% vs.41%), required fewer second operations (18% vs. 48%), and achieved a higher rate of breast conservation (88% vs. 70%) than did general surgeons. Similar improvement in outcome has been documented in Great Britain (Br J Cancer 90:1920-5) when care there is by Surgical Oncologists. Adequate surgical management of breast cancer as well as all other cancers is fundamental to improving outcome. Knowing what to do, when to do it, how to do it, and how what is done impacts subsequent care and outcome is the key. Coordination of care and surgery by a specialist who devotes his career and all his attention to comprehensive cancer care leads to fewer recurrences, a better chance of survival, and less stress on our patients. We want all patients to have the best outcome possible. Selecting a Surgical Oncologist for your surgery and cancer makes a difference!

What is a Surgical Oncologist?

BD Decker explains: The Surgical OncologistThe surgical oncologist is most often the first specialist to see a patient before other oncologic specialists. The primary physician most commonly pursues a diagnosis, and in circumstances where this requires biopsy, the surgeon is called. For decades, any surgeon was considered competent to exercise all surgical skills, including cancer surgery. Indeed, while most surgeons may be acceptably competent, the specialty of surgical oncology is increasingly becoming recognized. Surgical oncologists are clinical scientists with knowledge of and experience in cancer surgery that come from additional training, limitation of the scope of general surgical practice, familiarity with the biology and natural history of cancers, and the role of the other oncologic specialties in their diagnosis and management. Until surgical oncology becomes recognized by the proper accrediting agencies, other oncologists must exercise their judgment about the oncologic qualifications of their surgical confreres. Membership in the Society of Surgical Oncology, postgraduate training in a cancer institute or university program under a mentor known for cancer surgical expertise, concentration of surgical practice on cancer and related diseases, and publications are some of the appropriate criteria. Since a general surgeon may perform the biopsy, a surgical oncologist is on rare occasions called upon to supersede the first surgeon on the case. Herein lies some of the problem, since the primary cancer operation is of utmost importance for proper staging and for achieving surgical cure. In this regard, biopsy of any mass should be considered only in the context of whether the operating surgeon will be the best choice for eventual definitive surgical therapy. Since a considerable portion of their activity deals with neoplasia, thoracic surgeons, urologic surgeons, and neurosurgeons must be chosen for their general expertise because there is not likely to be an oncologic subspecialty in the near future for those specific organ systems. On the other hand, gynecologic oncology, orthopedic oncology, otorhinolaryngologic oncology, and surgical oncology are well defined, and the general gynecologist, orthopedist, otorhinolaryngologist, or surgeon is unlikely to be as well qualified as the oncologist within the specialty. Because the implications for a proven neoplasm, potentially resectable, entail many other considerations to optimize curability, the prudent surgical oncologist surveys the potential contributions of medical oncology, radiation oncology, and other specialties before proceeding with the operation. Where appropriate and possible, patients should be entered into clinical investigative trials. There is so much that is unknown about cancer that investigative activities should still be of prime concern to all oncologists. In institutions where investigative programs are not employed, sober consideration of joining in this effort through a community oncology program or in alliance with some other active institution should be exercised. In the absence of a structured protocol, joint assessment is appropriate to determine whether chemotherapy or radiotherapy prior to surgery may improve outcome. Most often, this entails direct consultation with the medical and/or radiation oncologist. An opportunity for the three specialties to see the patient in the native unaltered state is of great value for subsequent planning. Confidence building makes for easy consultation over the years with colleagues who share mutual trust. The treatment of breast cancer, rectal cancer, head and neck cancer, lung cancer, and soft tissue sarcoma, for example, are most often best approached by multi-disciplinary components from all three specialties. Whereas specific diseases may be treated well by single-modality approaches, bi-disciplinary or tri-disciplinary opinion is usually advantageous. Surgical oncologists must also be available for surgical aspects of management later in the course of disease. Venous access devices may be required, depending on the drugs to be used and the status of peripheral veins. End-staging laparoscopy or laparotomy, in many instances, may make more sense than earlier operation so that the medical oncologist may be certain that a complete clinical remission is pathologically confirmed, rather than waiting for a lymphoma or ovarian cancer to relapse. Intestinal obstruction in the course of cancer may require operative surgical management. A medical or radiation oncologist may discover a suspicious mass or infiltration that needs biopsy and pathologic assessment. Palliative surgery is an area where medical and radiation oncologists often present problems to the surgeon in hopes of potential operative remedy. Debulking, diverting, and pain-relieving operations are all appropriate procedures in the proper circumstance. Surgical oncologists also have legitimate interests in adjuvant chemotherapy and immunotherapy. For those willing to devote the time required for this undertaking, use of established drugs in adjuvant programs can be an improvement over surgical procedures alone. Indeed, the National Surgical Adjuvant Breast and Bowel Project (NSABP) has contributed significantly to our knowledge of adjuvant therapy for these diseases. Surgical oncologic investigators have also been among the pioneers of immunologic cancer research. The rarity of surgical oncologists in practice, however, ordinarily precludes these activities for surgeons, since so much of their time is ordinarily invested in pre- and postoperative care and in actual surgery. Medical oncologists must stand ready to assume primary responsibility for subsequent oncologic management. Orthopedic oncologists, otorhinolaryngologic oncologists, and neurosurgical oncologists ordinarily ally themselves with a medical oncologist with specialized interests and expertise in the treatment of neoplasms of their particular discipline.